Training activity information
Details
Perform vertical audit of a sample analysed for a ‘toxicology screen’
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Considerations
- Sample receipt, sample quality, timeliness, analysis, reporting, and retesting,
- Standard, guideline or consensus document for audit against
- Principles of audit and the audit cycle.
- Quality control; EQA and IQC
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- Understand the process of a vertical audit and its importance in ensuring the quality and integrity of the toxicology screening pathway.
- What is a vertical audit in the context of laboratory testing, particularly for toxicology? What is its purpose in ensuring quality and traceability?
- What are the key stages in the toxicology screening process that should be included in a vertical audit (e.g., sample collection, receipt, analysis, result reporting, interpretation)?
- What documentation and records are involved at each stage of the toxicology screening pathway? What information should be traceable?
- What are the relevant laboratory protocols and quality standards that need to be considered during the audit?
- What criteria or checklists are typically used to perform a vertical audit of a toxicology screen?
- How will you gain a comprehensive understanding of the entire toxicology screening pathway in your laboratory?
- How will you develop your skills in identifying potential weaknesses or areas for improvement in the toxicology screening process?
- How will this activity enhance your understanding of quality assurance principles within the clinical biochemistry laboratory?
- Discuss this activity with your training officer or the quality manager to understand the scope and focus of the audit and the specific sample you will be tracing.
- Review the relevant Standard Operating Procedures (SOPs) for all stages of the toxicology screening process in your laboratory, from sample collection to reporting.
- Familiarise yourself with the documentation systems used at each stage, including request forms, sample logs, instrument records, quality control data, and result reports.
- Understand the process for handling and storing toxicology samples.
- Consider potential challenges in accessing all relevant information or identifying discrepancies in the records.
- Reflect on your current understanding of the toxicology screening process and quality assurance measures.
In action
- What approach are you taking to undertake the vertical audit of the toxicology screen sample? What stages of the analytical process are you reviewing (e.g., sample reception, preparation, analysis, reporting)? What documentation and records are you examining at each stage? Why are these specific elements important to audit?
- What checks and comparisons are you making at each stage? Are you looking for completeness of information, adherence to protocols, consistency of data, and appropriate sign-offs?
- How effectively are you able to trace the sample’s journey through the laboratory and identify all relevant records and documentation? Are you noticing any gaps or inconsistencies in the process?
- What challenges are you encountering during the audit? For instance, are some records difficult to locate, incomplete, or unclear? Are there any discrepancies in the data recorded at different stages?
- What can you learn about the end-to-end process of toxicology screening and the importance of quality assurance through this audit? How do different departments or sections within the laboratory interact in this process?
- How does this activity relate to your understanding of laboratory quality management systems, audit trails, and the need for continuous improvement in laboratory practice?
- If you discover a deviation from the expected procedure or a non-conformity during the audit, are you considering how this should be documented and reported according to laboratory policy?
- Are you conducting the audit according to the established audit plan or protocol and using any required audit tools or checklists?
On action
- Describe the process you followed for the vertical audit of the toxicology screen sample. What stages of the analysis did you review? What documentation did you examine, including request forms, analytical records, and result reports? Were there any discrepancies or issues identified during the audit process? What were they? What aspects of the toxicology screening pathway were you able to trace through the audit?
- What did you learn about the end-to-end process of a toxicology screen, from sample receipt to reporting? How did this activity highlight the importance of each step in the analytical pathway and the potential impact of errors? What did you learn about the documentation and quality control measures involved in toxicology testing? Did the audit identify any areas where processes could be improved?
- How will you apply your understanding of the toxicology screening pathway in your future work? What key areas will you focus on to ensure the quality and integrity of toxicology testing? How can vertical audits contribute to continuous improvement within the laboratory? What further information or training on audit processes might be beneficial?
Beyond action
- Since performing this vertical audit, have you been involved in or learned about other audit processes within the toxicology or wider laboratory? How does this initial experience compare to those?
- Have you gained a deeper understanding of the quality management systems and the importance of traceability throughout the entire testing process for toxicology samples?
- Reflect on any changes or improvements that have been implemented in the toxicology screening pathway since you performed this audit. How does your initial audit experience relate to these changes?
- Has your experience with the vertical audit made you more conscious of the importance of accurate documentation, record-keeping, and adherence to standard operating procedures in all areas of your laboratory work?
- Has this DTA enhanced your understanding of the interconnectedness of different stages in the toxicology testing process and the potential impact of errors at any point, from sample collection to reporting?
- If you were to be involved in future audit activities or quality improvement initiatives within the toxicology department, how would your initial experience with the vertical audit inform your approach?
- Could the skills you developed in systematic review, identifying potential risks and areas for improvement, be applied to other problem-solving tasks or quality management activities in the laboratory?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Analyse drugs, vitamins and trace elements in various biological matrices via quantitative and qualitative assays using automated and manual methodologies. |
| # 2 |
Outcome
Apply the appropriate investigative strategy to clinical situations which may involve drugs or poisons, advising clinical teams on the appropriate course of action. |
| # 3 |
Outcome
Appraise the methods in routine use for ‘drugs of abuse’ screening and advise on the interpretation of common analytes. |
| # 4 |
Outcome
Summarise the limitations of comprehensive toxicology screening in clinical practice. |
| # 5 |
Outcome
Demonstrate the application of pharmacokinetics and pharmacogenomics in therapeutic drug monitoring. |
| # 6 |
Outcome
Illustrate how toxicology results are used in clinical practice and the legal consequences of drug testing in various settings. |